The present invention relates generally to systems and methods for the driving of a needle or suture through or into body tissue (typically, the needle will be affixed to a suture that remains in the tissue) using a catheter, introducer or other minimally invasive means. The methods and devices described herein can be used in any number of medical procedures, including but not limited to, approximating tissue (e.g., bring separated tissue together), ligating tissue (e.g., encircling or tying off), and fixating of tissue (attaching tissue to another structure or different tissue).
Commonly known suture systems mechanically drive needles thru the tissue wall to create passage for a suture. Such mechanisms are often complicated and require a skilled operator. In addition, the conventional mechanisms can involve many procedural steps to manipulate a needle to conform to a path to properly position the suture into tissue.
Conventional suture driving systems used for wound closure provides one example of existing suture driving systems. Such wound closure systems are used in transluminal medical procedures that are seeing a rise in popularity due to the reduction in surgical damage to healthy tissue, decreased recovery time, and ultimate cost savings to the patient associated with these procedures.
These transluminal procedures typically require a puncture into a body lumen and through the overlying tissue for the passing of catheters, guide wires, laparoscopes, endoscopes, vascular devices, etc. as required by the particular procedure. The punctures are created with instruments such as access needles, trocar, introducer sheaths, or other access devices and may measure from 1 to upwards of 15 mm in diameter. After completion of the procedure, the physician can utilize a closure system to close the puncture quickly to prevent further bleeding.
Manual compression of arterial or venous punctures is a common closure technique and an alternative to such closure systems. In this closure technique, medical personnel apply continuous pressure to the wound site allowing the blood to eventually clot sufficiently sealing the wound. However, this technique is typically very time consuming, requires the patient to bedridden for an extended time, and is not applicable for punctures over 4 mm. The longer recovery time increases overall cost and decreases patient satisfaction.
Sutures remain the preferred method of sealing such wounds, but the limited access and small size of the typical wound formed during a transluminal procedure complicates the task of sealing these wounds.
Generally, a physician must introduce a suture needle through the tissue tract and into the body lumen, position the needle, then passed the needle through tissue pulling the suture through as well. A number of devices are disclosed in U.S. Pat. No. 5,374,275 to Bradley et al., U.S. Pat. No. 5,364,408 to Gordon, U.S. Pat. No. 5,320,632 to Heidmueller, U.S. Pat. No. 5,403,329 to Hinchcliffe, U.S. Pat. No. 5,368,601 to Sauer et al., U.S. Pat. No. 5,431,666 to Auer et al. and international publications WO 94/13211 and WO 95/13021 each of the above references is incorporated by reference herein.
While these devices allow for sealing of the wound and driving the suture and needle through tissue, they are relatively complex and employ a significant number of moving parts. Accordingly, these devices are relatively costly to produce and are prone to mechanical failure.
U.S. Pat. Nos. 5,527,322, 5,792,152, 6,206,893, and 6,517,553 all to Klein U.S. and Pat. No. 5,972,005 to Stalker (each of the above references is incorporated by reference herein) describes devices employing flexible or pre-shaped curved needles that are deformed from a natural shape during insertion or during advancement in tissue to close a puncture wound. U.S. Pat. No. 7,377,926 to Topper et al. (incorporated by reference herein) teaches another system for inserting a needle. In this variation, the insertion device houses a bendable needle in one of the jaws and is adapted to carry a suture
However, systems, such as those described above often deform a needle to drive a suture. Deformation of the needle in this manner often results in device malfunction when placing the suture, or requires significant additional complex components to ensure proper movement of the needle and suture as desired. Accordingly, there remains a need for a simple mechanized device and method to accurately and precisely drive a suture through tissue in a constrained space such as is required in less invasive procedures.
In addition, the methods and systems described herein have additional uses other than closure of tissue. In another example, U.S. Patent Application No. 20070203479 to Auth et al. (incorporated by reference herein) describes methods and devices, and systems for the partial or complete closure or occlusion of a patent foramen ovale (“PFO”). An improved suture driving device can be used for fixating tissue and eliminate the need for such implantable devices.
Accordingly, the need continues to exist for an improved suturing systems and methods that drive a suture for approximating tissue, ligating tissue, and/or fixating of tissue.